The Often Injured Lifter

Whether I like it or not, around these parts I've become
known as an "injury guy." People get jacked up
doing stupid stuff, and guys like Mike Robertson, Bill Hartman, and
myself fix them up by pointing out that said "stuff" is,
in fact, stupid.

To that end, a lot of my consulting work is done in the
corrective exercise realm — basically handling people who
fall into the gray area between physical therapy and healthy
training... bridging the gap, so to speak. We know that 80% of
Americans will have lower back pain at some point in their lives,
and 70% of gym-goers will experience shoulder problems somewhere
along the line, but we can't send all of these people to
physical therapy.

What do we do with them?

Many times, the people who ask this question are also the ones
who question how I can possibly help people with their injuries via
online mediums. The truth is that it isn't rocket science or
really anything more complex than basic algebra if you understand
functional anatomy.

A Real World Example

Rather than get really geeky on you with a textbook outline of
what I do, I figured it would be best to highlight a representative
example from an online consulting client of mine who was about as
jacked up as they come. We'll call him Ben Hurtin.

Here was Ben's self-report in my initial

"In September 2006, I sought the help of another very well known
strength trainer. I basically gave him the same info I've given
you, however, I was very disappointed in his program. I'm
excited about the program you'll be developing for me; you
definitely have your work cut out for you.

"My shoulders have hurt on and off for seven years. Now the left
shoulder and rear delt area bothers me when pressing. The left
front delt hurts when I do heavy close-grip presses. My shoulder
pain typically moves from one shoulder to another; however, my left
shoulder has hurt consistently for the last two months or so. My
left shoulder clicks and grinds occasionally, with no pain.

"My hips have hurt for two years when doing squats, left one at
first, now both. Pain subsides after a few sets, but I hurt for
three to four days after squat sessions. Lower back has hurt for
around two years as well. Hurt it doing deadlifts about a year ago.
Squats hurt my lower back until I started stretching.

"My elbows hurt most of the time. I can't do skull crushers
at all. Hammer curls and reverse curls hurt my elbow area as
well, so I don't do any forearm work. The back side of my
entire arm, from wrist to elbow, hurts when I do heavy barbell
curls. I haven't done any curls in almost a year. My knees
feel great until I try to do interval training on the treadmill.

"I've had cortisone shots in both shoulders, both hips, right
elbow, and lower back. None in the last year. I stretch my lower
back daily and use a foam roller for my hips daily as well. I do
use DMSO on my shoulders and elbows. I felt DMSO was pretty
effective. I haven't used any in the last three weeks, however. I
haven't benched or done military press in almost a month to
give my shoulder a break.

"Problematic exercises: bench press, close-grip press, military
press, squats, pull-ups with an overhand grip, skull crushers,
hammer curls, reverse curls."

When I asked Ben for his last four weeks of training, here was
the response I received:

"I train from 9AM to 10:30AM, Monday through

Monday: Chest, triceps

Flat bench press, 5 sets of as many reps I could do —
typically 3 to 6 reps

Close-grip bench — 4 sets — 10, 8, 6,

Triceps pressdowns — 4 sets — 10, 8, 6,

Reverse pec dec — 4 sets overhand grip — 12, 10, 9,

Reverse pec dec — 4 sets underhand grip — 12, 10, 9,

Walk on treadmill or interval training on treadmill — 20
to 30 minutes

Tuesday: Back

Pull-ups — neutral grip — 8 sets of 5 with 50lbs to
70lbs attached

Chest supported T-bar row — 3 sets — 8, 6, 5, 4
(just recently started this one)

Seated cable rows — 3 sets — 8, 6, 5,

One-arm cable rows — 3 sets — 8, 6, 5,

One-arm dumbbell rows — 2 sets — 6, 5

Walk on treadmill or interval

Wednesday: Shoulders

Seated dumbbell press — military — 5 sets —
10, 9, 8, 7, 6

Seated barbell press — military — 3 sets 6, 5,

Seated lateral raises — 4 sets — 7, 6, 5,

Seated rear delt raises — 4 sets — 7, 6, 5,

Standing cable lateral raises — 3 sets — 7, 6,

Standing cable rear delt raises — 3 sets — 7, 6,

Barbell shrugs — 5 sets — 15, 12, 10, 9,

Walk on treadmill

Thursday: Legs, back

Squats — 5 sets — 8, 7, 6, 5, 4

Squat machine — 4 sets — 6, 5, 4, 3

Leg curls — 4 sets — 10, 9, 8, 8

Standing cable hamstring curls — 3 sets — 10, 9,

Pull-ups — 3 sets 10 reps

Seated cable rows — 3 sets 8 to 10 reps

One-arm cable rows — 3 sets 8 to 10 reps

Walk on treadmill

Friday: Chest, triceps, shoulders

Incline dumbbell press — 5 sets — 10, 9, 8, 7,

Close-grip bench — 4 sets — 6, 5, 4,

Triceps pushdowns — 4 sets — 7, 6, 6,

Seated lateral raises — 3 sets — 8, 7,

Seated rear delt — 3 sets — 8, 7, 6

Cable lateral raises — 3 sets — 9, 8,

Cable rear delt — 3 sets — 9, 8, 7

Walk on treadmill or interval

I try to do abs several days a week at home. I use the ab
scissor. I try to do rotator cuff exercises three times a week at
home. I've done these for several months. I've stopped these at
this point because I don't know if they're helping or

Ben also took the following supplements:

Multivitamin, B-complex, Ester C, fish oil, Vitamin E, Beta
Carotene, NAC, ALA, R-ALA, ZMA, Chromium Picolinate, Acetyl-L
Carnitine, Glucosamine & Chondroitin, D-Ribose, Taurine,
Creatine, Glutamine, Orotic Acid, Citrulline Malate, Beta Alanine,
BCAA's , and protein powder.

Quite a hefty supplement bill for a guy who's so banged up that
he can hardly train!

The first thing you'll notice is that Ben never actually
discussed a pathology. It's not like he knows he has a torn
labrum or herniated disc. Pretty much all the pain comes about when
he lifts, meaning that it's largely self-imposed and

Most doctors will simply tell Ben that if an exercise gives him
pain, he shouldn't do it (incidentally, this is also the
extent of the wisdom of the "hamster wheel supervisors"
at Curves). I agree that he shouldn't be in pain, but just
avoiding the problem isn't going to fix anything. Ben needs to
eliminate the cause of the problem and work to correct it. Mr.
Hurtin is a classic "gray area" guy.

Program Dissection

Let's dissect our banged-up weekend warrior's program
in greater detail.

1. When I asked Ben for his program, all he sent me was a list
of resistance training exercises, sets, and reps. This is a good
start, obviously, but where's the dynamic flexibility warm-up? When
is he doing soft-tissue work in the form of foam rolling and
lacrosse ball?

Lifting is a large piece of the puzzle, but certainly not the
entire puzzle. Ben needs to realize that in order to move big
weights he's going to have to attend to the length and quality
of his tissues — even if that isn't as sexy as an extra four
sets of bench presses.

2. There's absolutely no structural balance in this program.
Here are the glaring weaknesses I see on this front:

• Far more shoulder internal rotation than external

• Far more scapular elevation than depression

• No single-leg exercises

• No hip dominant exercises

Just incorporating some lunge variations, deadlifts, external
rotations, and rows done correctlywould go a long way in
fixing his problems.

3. In my humble but hopelessly blatant opinion, leg curls are
crap from a functional anatomy perspective; the hamstrings never work independently of the glutes. To quote my good
friend and colleague Carl Valle, "You can't have Popeye
hamstrings and an Olive Oyl ass."

4. Interval training is just randomly thrown in there whenever
Ben feels like it. Believe it or not, fluctuation of training
stress is more important than you might think when it comes to
fixing imbalances. If your whole system is beaten up all the time
— so much that it can't even recover from acute stress
— how can you expect it to fix chronic problems at the same
time? Ben never mentioned how he deloads.

5. There's a ton of overlap in this program. Does Ben
really need to do both dumbbell and barbell military presses? And,
with his history of shoulder problems, does Ben need to be doing
military presses at all? Hell, does he even need a full
"shoulder day" on Wednesday when he's already
pressing twice a week?

6. The program makes no mention of it, but it's fair to
assume that it isn't just a function of what Ben is
doing, but howhe's doing it. There are very few
exercises that are genuinely bad, but there are an infinite number
of exercises that can be made dangerous with incorrect technique.

I outlined some common bench press blunders in Shoulder Savers:
Part I.
The response to these simple videos was so good that Mike Robertson
and I decided to devote two DVDs of our Building the Efficient
Athlete set purely to detailed troubleshooting technique on over thirty
common resistance training exercises.

7. Ben is doing plenty of bench presses, but no push-ups.
Don't get me wrong, as I love the bench press. It's just
that you need to complement open-chain upper body work (e.g.
benches) with closed-chain upper body work (e.g. push-ups).

In the former scenario, the scapulae are fixed, and in the
latter, the scapulae are free to move. Even just working some
push-up variations in during the warm-up period or on off-days can
dramatically improve shoulder health.

8. Ben is doing five exercises on machines in this program. As
far as I'm concerned, when you're banged up, this number
should be zero. Incidentally, it should also be zero when
you're healthy, drunk, incarcerated, pregnant, or in a
vegetative state after being kicked in the head by a

9. Ben has a training age of seven years, yet he's lifting
with the volume that would typify a program from a newbie who just
picked up his first muscle magazine. The longer you've
trained, the less you can do; it's just that simple. Advanced
lifters recruit more muscle fibers than novice and untrained
lifters, so every rep "counts" more toward accumulated
fatigue and the overall training effect.

10. The idea of training five days "on" and two days
"off" is just plain silly, in my opinion. I prefer a
Monday, Tuesday, Thursday, Saturday set-up whenever possible, with
a Monday, Tuesday, Thursday, Friday approach in second place. Very
few people can get away with five days of lifting per week, and
even fewer can do them consecutively.

As I mentioned, this is just the tip of the iceberg. And
I'm sure you're thinking, "One specific programming
example isn't necessarily applicable to what I'm doing." I agree completely, and that's why I've
compiled this ten-point list of how to approach corrective exercise
while still maintaining a solid training effect.

The Rules

Rule #1: Fit the program to the lifter, not vice versa. The best
way to correct dysfunction is to prevent it. If you're blindly
following cookie-cutter programs, stop.

Rule #2: Learn to program for yourself. Establish a small group
of people who will give you honest feedback on your programming
ideas, and then use your intuition when it comes to modifying
things on the fly.

If you're strapped for time, pay someone else to write
your programs and provide them with a ton of information about

Rule #3: Some exercises just aren't worth it. Don't
bother with them; there are better options available to

Rule #4: You can never have too much information. Ask a lot of
questions and consider every angle — and know when to refer
out to a professional more qualified than you to handle the problem
in question.

Rule #5: Think "correct" before you think
"different." If an exercise causes pain, stop performing
it. Evaluate technique before moving on, though. If performing the
exercise correctly alleviates pain, keep it. Chances are that
correctly performing the exercise will actually help correct the
imbalance. An athlete will be more receptive to "do it this
way instead" than he will to "don't do

Rule #6: Make the athlete feel like an athlete — not a
patient — both physically and psychologically. Tell them what
they can do.

Rule #7: Before you go changing what's going on in the gym,
figure out what you can do to improve what's going on outside
of it. Think posture, repetitive motions, sheer lack of movement,
sleeping posture, footwear, and even poor diet.

Awesome vs. Atrocious

Rule #8: Soft-tissue work serves a valuable role in preventing
and correcting imbalances, without making any programming
modifications. Foam rolling and lacrosse ball work is cheap and
effective. Just do it.

Rule #9: Implement mobility and activation work in your warm-up.
It only takes 5-10 minutes, which is a lot less time than it takes
to recover from an injury. You'll be amazed at what shakes
free when you enhance stability through full ranges of

Rule #10: As a last step, modify the training plan — and
only on a small-scale, if possible. This is the most
"sacred" aspect of an athlete's preparation, so you
should butcher it as little as possible. The more you screw with
things, the more the athlete is going to feel like a

Closing Thoughts

It might sound like a terrible thing to say, but I hope that you do encounter some sort of musculoskeletal injury or
condition at some point in your training career. It'll make
you realize how much you appreciate being able to train, and
you'll learn a lot about what you were doing wrong in the

As hackneyed as the phrase may seem, whatever doesn't kill
you makes you stronger.